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General Practice

5. Simon Hughes (Southwark, North and Bermondsey): What assessment he has made of (a) the availability of and (b) access to general practitioner services in Greater London. [135973]

The Minister of State, Department of Health (Mr. John Hutton): The number of GPs, and the number of GPs in training, in London are currently at the highest recorded levels, helping more patients to be seen more quickly. Primary care trusts in London are also committed to further increases in the number of GPs and primary care professionals, which will help further to improve access to, and availability of, primary care services. Primary care in London will also benefit from £350 million-worth of capital investment in the next two years.

Simon Hughes : Is the Minister aware that a broad-ranging survey over the summer showed that more than one third of GP surgeries had closed their lists to new patients, and that more than half had closed their lists in the previous 12 months? As a result, thousands of people in London cannot get on to a GP list on a given day. What does the Minister propose to do to improve that situation substantially and quickly, and is there a target date—a number of days—by which somebody who wants to register on a GP's list can be sure that they will have a doctor to go to?

Mr. Hutton: On the hon. Gentleman's last point, my understanding was that his party was against new targets of any kind for the national health service; perhaps he needs to talk to the hon. Member for Sutton and Cheam (Mr. Burstow) about that. I accept that his first point constitutes a serious and genuine concern, but I should point out that existing arrangements do permit a primary care trust, in some circumstances, to allocate a patient, or group of patients, to practices. Although everyone accepts that that is not ideal, it is possible to get an appointment with a GP through that route if it is the last one available. Secondly, I remind the hon. Gentleman that the general medical services contract that we have concluded with the British Medical Association provides a new mechanism for dealing with precisely such issues, which I hope will prevent some of the situations that he describes from arising as frequently in future. I accept that, clearly, there are capacity constraints, and measures are in hand to deal with that. The arrangements under the new GMS contract will provide a further strengthening of those measures.

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Maternity Services

6. Dr. Doug Naysmith (Bristol, North-West): What plans he has to increase choice in the provision of maternity services. [135974]

The Secretary of State for Health (Dr. John Reid): My Department is conducting an extensive consultation on what patients want in terms of choice and involvement in, and flexibility of, their care and treatment. Maternity services are a key theme of this consultation.

Dr. Naysmith : I thank my right hon. Friend for that reply, and I hope that he has had a chance to look at the Health Committee's reports on maternity services, which were published earlier this year. One of our recommendations was that the ability should exist to be referred to midwifery services by a midwife, rather than through the GP services. I should be grateful if he would outline what the Department intends to do to encourage that.

Dr. Reid: It is true that choice becomes substantial choice only if capacity is increased and investment to increase that capacity is made. That is the difference between our policy and the theoretical and cruelly deceptive choice that is offered by others to benefit only a tiny minority of people. We have therefore increased capacity through investment, resources and training in order to give women a real choice over maternity services. For instance, I understand that in my hon. Friend's area in Bristol, a number of midwives have proposed a midwife-led unit as an alternative to traditional hospital-based maternity services, and the primary care trust is now actively considering that option. We aim for the NHS to provide maternity services that offer women a variety of options through which they can receive care during their pregnancy and where they give birth.

Dr. Richard Taylor (Wyre Forest): What plans does the Secretary of State have to deal with the shortage of midwives, which risks curtailing choice for patients and specifically curtailing the midwife-led birth centres that he mentioned? I would be grateful to know that he attaches a great deal of importance to such midwife-led centres and I hope that, because of the shortage of midwives, he will protect them from attacks by the consultant-led obstetrics units.

Dr. Reid: On the hon. Gentleman's second point, it is crucial that we do not allow any vested interest to stand in the way of better-quality, quicker and better service and more choice for patients. When I say that, I mean any vested interests within the NHS or any vested interests from outside that want to undermine it. I can tell the hon. Gentleman that I will make sure that we protect and help to prosper the midwife-led opportunities.

On the first part of the question, we have an expectation that, from a baseline of the year 2000, more than 2,000 extra midwives will be working in the wards by 2006. As the hon. Gentleman may already know, in September last year, there were 870 more midwives working in the wards than when we took power in 1997. It is not easy, but we are putting in the investment to

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attract people back. It would be a disaster if we had cuts in investment on the scale envisaged by the so-called Opposition.

Mr. Ivan Henderson (Harwich): May I tell my right hon. Friend that my constituents welcome the news that Harwich is going to get a new community hospital, which includes a new maternity unit? That will continue to give my constituents a choice about where to give birth in their local community. However, at the moment, the existing maternity unit is temporarily closed because of the shortage of midwives. To ensure that the new hospital and new maternity unit is a success, will my right hon. Friend do all that he can to ensure that we recruit, retain and encourage midwives back into the profession? We want the investment to make an improvement, which counters the suggestions of failure from Conservative Members—[Interruption.]

Mr. Simon Burns (West Chelmsford): It's closed.

Dr. Reid: Despite the baying from Conservative Front Benchers, that is a helpful question because it is important to have an honest appraisal of where we are with the health service. It is light years better than the health service that we inherited from the crowd on the Opposition Benches, but we still have a long way to go—[Interruption.] I can do no better than quote Professor Mike Salmon, chairman of the Essex Rivers Health Care NHS trust. When the Government gave the go-ahead in 2001 to the project mentioned by my hon. Friend, he said:

It is certainly much better news than anything that appeared during the near 20-year reign of the crowd opposite. Nevertheless, we have a great deal more to do to attract more midwives. We are increasing the number of training places and there are now 470 more than in 1996–97—an increase of 28 per cent. We are also taking a range of further actions to help recruitment. All of that would be put in peril by the massive cuts in investment proposed by Conservative Members.

Mr. James Gray (North Wiltshire): It is unfortunate that the Secretary of State allowed some party political banter to creep into what had until then been the helpful answer that he was determined to put women's interests first when deciding on maternity services. Will he bring his influence to bear on the Avon, Gloucestershire and Wiltshire strategic health authority, which is currently consulting on closing down maternity services in Trowbridge, Devizes and Malmesbury?

Dr. Reid: I do not understand the logic of the hon. Gentleman's question. My God, if in the context of the biggest annual increase in the NHS for the longest period in history, he is keen to point out to us where difficulties occur, what will he do when there is a 20 per cent. cut in that investment?

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Mr. Gray: That is no answer. What a disgrace. Get back to Scotland.

Mr. Speaker: Order. The hon. Gentleman should not say too much about Scotland. He knows where I come from and it is not so long ago that he lived in my constituency.

General Practice

7. Mr. Peter Pike (Burnley): What additional funding his Department is making available for the improvement in the (a) premises and (b) facilities available at general practitioners' surgeries in England. [135975]

The Minister of State, Department of Health (Mr. John Hutton): The Government are committed to investment of £1 billion by 2004 in improving primary care premises and facilities through NHS LIFT—local improvement finance trust—and other investment routes. The NHS LIFT scheme in east Lancashire, which I was able to visit last Friday, has reached financial close and work has now started on the first of several new developments, which will include my hon. Friend's constituency.

Mr. Pike : As my hon. Friend mentioned, he was in Bacup last week and he will know that many surgeries in my constituency do not meet the standards for primary care in GPs' surgeries that the Government want to deliver in 2003. Does he believe that the LIFT programme and what Burnley, Pendle and Rossendale primary care trust is doing will ensure that we have such facilities, and will they be value for money?

Mr. Hutton: I do believe that. As my hon. Friend knows, the primary care trust has started with three developments initially, in Bacup, Nelson and Darwen. I understand that GPs in his constituency will be in the second tranche of development and I hope that that will proceed as soon as possible. I agree with him that it is desperately important that we improve the primary care estate in the NHS. It is where 90 per cent. of all patient journeys begin and end and, as GPs would themselves acknowledge, it is true that many surgeries are not up to scratch. They are not capable of delivering modern, 21st-century health care. That is why we are making a record investment in primary care, and there is no more pressing case than my hon. Friend's constituency.

Mr. Crispin Blunt (Reigate): Will the Minister direct some of the additional funding for primary care to areas where GP lists are well above the national average, such as in my constituency, or will he continue to be a party to the fiddling of formulae that will continue the crisis in public service provision in the south-east of England?

Mr. Hutton: No, we do not fiddle any formulae. Health spending is directed to the areas of greatest need. That is precisely the methodology we use to distribute money across the national health service. The hon. Gentleman has recently had something of a reputation for espousing the causes of the vulnerable. I imagine that that is why he is especially pleased to see what has happened to the right hon. Member for Chingford and

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Woodford Green (Mr. Duncan Smith), who must surely now be included on a list of the vulnerable. There are 42 LIFT schemes across the country and I am more than happy to send the hon. Gentleman details of them so that he can judge for himself whether the figures have been fiddled, as he alleges.

Alan Simpson (Nottingham, South): There is overwhelming public support for the Government investment programme in the renewal of GP facilities, but will the Minister look carefully at the value-for-money aspect? The first of the LIFT proposals in my constituency includes plans for a £5 million health centre that will be rented back to the NHS at a cost of £25 million, an effective interest rate of more than 20 per cent. I asked some of the high street building societies what they would charge me for a mortgage to build it myself and discovered that it would cost £8 million. Can the Minister look carefully at the long-term costs and constraints imposed on LIFT companies to ensure that we get the modern facilities that we need but not at the Barclaycard interest rates that we do not?

Mr. Hutton: NHS LIFT schemes do represent value for money. I understand that my hon. Friend has an ideological opposition to involving the private sector in the construction of NHS facilities. I respect that, but I profoundly disagree with him about the implications for NHS LIFT. All NHS LIFT schemes must pass a value-for-money test, and they do so. However, I can tell my hon. Friend and anyone else who is worried about the matter that the priority is to get the investment in place so that primary care facilities for NHS patients can be renewed. NHS LIFT represents a once-in-a-generation opportunity to make a significant and real difference to the improvement of primary care facilities in my hon. Friend's constituency, and in the constituencies of hon. Members of all parties. That should be our priority.

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